PRINTER'S NO. 3166
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
2320
Session of
2024
INTRODUCED BY VENKAT, HILL-EVANS, GUENST, PROBST, HADDOCK,
ROZZI, STEHR, KENYATTA, HANBIDGE, GIRAL, SANCHEZ AND
D. WILLIAMS, MAY 22, 2024
REFERRED TO COMMITTEE ON AGING AND OLDER ADULT SERVICES,
MAY 22, 2024
AN ACT
Amending the act of June 13, 1967 (P.L.31, No.21), entitled "An
act to consolidate, editorially revise, and codify the public
welfare laws of the Commonwealth," in public assistance,
providing for pending medical assistance applications.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of June 13, 1967 (P.L.31, No.21), known
as the Human Services Code, is amended by adding a section to
read:
Section 449.3. Pending Medical Assistance Applications.--(a)
When a medical assistance application for an individual residing
at a long-term care provider has been pending at the department
for at least sixty days for either of the following reasons, the
provider may request an uncompensated care payment from the
department:
(1) the determination of an initial or renewal application
of medical assistance has not been made; or
(2) the initial medical assistance application was denied
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and an appeal was submitted and received by the department to
amend the application.
(b) The department shall make payment to the provider for
the uncompensated care as though the application were approved,
beginning on the date of request. Payment under this subsection
shall not be made for the period prior to the provider's
request, but shall continue thereafter until the department
makes a final determination on the application.
(c) In the event the determination for benefits is denied,
the department shall have the right of recovery, offset or
recoupment with respect to payments made for the period
beginning with initial application through sixty days following
the request of the provider to receive payment. The department
may not recover, offset or recoup payments received after sixty
days of the provider's request for payment. In the event the
application is approved, the department may offset payments due
for the period between the date of the provider's request and
the final determination by amounts already paid.
(d) A provider providing uncompensated care to a medical
assistance applicant may inquire of the secretary or designee as
to the status of the individual's application, and the secretary
or designee shall respond within five business days as follows:
(1) If the provider has not obtained a signed release, the
secretary or designee shall provide the following information,
only, in writing:
(i) whether or not the application has been approved;
(ii) the identity of any authorized representative; and
(iii) if the application has not yet been decided, whether
or not the application is a complete application.
(2) If the provider has obtained a signed release, the
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secretary or designee shall, in addition to the information
listed in paragraph (1), provide any other information requested
by the provider, to the extent that the release permits its
disclosure of the information.
(e) For purposes of this definition, the term "long-term
care provider" or "provider" means a long-term care nursing
facility that is:
(1) licensed by the Department of Health;
(2) enrolled in the Medical Assistance Program as a provider
of nursing facility services; and
(3) owned by an individual, partnership, association or
corporation and operated on a profit or nonprofit basis.
The term does not include an intermediate care facility for
persons with an intellectual disability, Federal or State-owned
long-term care nursing facility, veterans' home or county
nursing facility.
Section 2. This act shall take effect in 60 days.
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